Introduction

Over recent decades the early management of acute stroke has changed dramatically and the early post-stroke period has been the focus of much research. With advances in pharmacotherapeutics, and on the basis of many randomized controlled trials, the potential interventions now available within the first 24–48 hours following acute stroke are numerous.

This chapter will present the evidence and best practice guidance for interventions during the first 24–48 hours following stroke, based upon the European Stroke Organisation Guidelines 2008 and the European Stroke Initiative recommendations for the management of intracranial hemorrhage [1,2]. For the purposes of this chapter, the interventions discussed will generally be limited to the initial 48 hours following ictus. Access to some of these therapies may not be universal and may be dictated by local availability at individual stroke units. As with other aspects of stroke care, however, close cooperation and inter-disciplinary communication are essential.

Thrombolysis

In respect of acute interventions, one of the most significant advances during the last two decades has been the introduction of intravenous thrombolysis as a standard therapy for a well-selected population of patients with acute ischemic stroke. At present, the only thrombolytic agent licensed in Europe for the treatment of ischemic stroke is recombinant-tissue plasminogen activator (rtPA), alteplase.